Aizkua dziedzera vzis.

Aizkua dziedzera vzis.

Pancreatic cancer has been brought to the forefront by the diagnoses of several prominent figures, including the late actor Patrick Swayze, who died of pancreatic cancer in September 2009, Apple cofounder and CEO Steve Jobs, and U.S. Supreme Court justice Ruth Bader Ginsburg.

37.680 - 34.290 = 3390The American Cancer Society estimated that 37,680 people in the U.S. were diagnosed with pancreatic cancer during 2008. Of those diagnosed, 34,290 will die of the disease, making this type of cancer the fourth leading cause of cancer death overall.

Handbook ofEvidence-BasedRadiation Oncology.2nd Edition

Eric K. Hansen, MD The Oregon Clinic Radiation Oncology Providence St. Vincent Medical Center Portland, Oregon, USAMack Roach, III, MD, FACR Professor, Radiation Oncology and Urology Chair, Department of Radiation Oncology UCSF Helen Diller Family Comprehensive Cancer Center University of California San Francisco San Francisco, California, USA

OncologyAn Evidence-Based Approach.

With 346 Figures in 501 PartsEdited byAlfred E. Chang, MDHugh Cabot Professor of Surgery; Chief, Division of Surgery Oncology; Department of Surgery, Universityof Michigan, Ann Arbor, MichiganPatricia A. Ganz, MDAmerican Cancer Society Clinical Research Professor, Director, Division of Cancer Prevention andControl Research, Jonsson Comprehensive Cancer Center at UCLA, Professor, Schools of Public Healthand Medicine, University of California, Los Angeles, Los Angeles, CaliforniaDaniel F. Hayes, MDClinical Director, Breast Oncology Program, University of Michigan Comprehensive Cancer Center,Ann Arbor, MichiganTimothy J. Kinsella, MDVincent K. Smith Professor and Chairman, Department of Radiation Oncology, University Hospitals ofCleveland, Case Western Reserve University, Cleveland, OhioHarvey I. Pass, MDProfessor and Chief of Thoracic Surgery, Department of Cardiothoracic Surgery, Head, ThoracicOncology, New York University School of Medicine and Comprehensive Cancer Center, New York,New YorkJoan H. Schiller, MDMelanie Heald Professor of Medical Oncology, Department of Medicine, University of WisconsinComprehensive Cancer Center, Madison, WisconsinRichard M. Stone, MDAssociate Professor, Department of Medicine, Harvard Medical School, Clinical Director, Adult LeukemiaProgram, Dana-Farber Cancer Institute, Boston, MassachusettsVictor J. Strecher, PhD, MPHProfessor and Director, Health Media Research Laboratory, Department of Health Behavior and HealthEducation, University of Michigan School of Public Health, Associate Director, Cancer Prevention andControl, University of Michigan Comprehensive Cancer Center, Ann Arbor, MichiganForeword by Gabriel N. Hortobagyi, MD, FACP

TxNxM1

The Anatomy and Clinics of Metastatic CancerBy Dr. J.M. Debois

KLUWER ACADEMIC PUBLISHERS,NEW YORK, BOSTON, DORDRECHT, LONDON, MOSCOW

Aizkua dziedzera aundabgs audzjs prsvar adenokarcinoma no aizkua dziedzera vadu epitlijaC 25.-Incidence: 10 gadjumi/uz 100,000 populcij/gad; 23% no visiem maligniem audzjiem; vriei:sievietes = 4:3; vecums: 6080 g.

Veicinoi faktori.Cukura diabts. Dita bagta ar gau un taukiem. Hronisks aizkua dziedzera iekaisums (pankreatts).Smana.Izoperts ultspslis. Iedzimtba t.i., imenes predispozcija (k.p., Peutz-Jeghers sindroms)

imiklijas k riska faktori.

Toksiskas imiklijas: 2-naphthylamine, benzidine, DDT.

Simptomi.Vemana. Slikta da.Svara zaudana.Nogurums.Hiperglikmija.Vdera tska.Hepatomeglija.Caureja.Spes vder.-Artrts trijs vai vairk loctavu zons.Apettes zudumi.Tums urns.Gaiki izkrnjumi.Dzelten kaite.Splenomeglija.Sataustms ultspslis.-Spes mugur.Spes pakrt.

Nav specifiski simptomi agrn stadij. Vlns slimbas stadjs:Pamatsimptomi: slikta da, anoreksijaSvara zudums (80% pacientu)Spes (jostveida spes) vdera augda un mugurpus.Ikterus (50% pacientu; dzelte bez spm ir aizdomga ka notikusi aundabga ultsvadu obstrukcija).Kurvuazj simptoms Courvoisier.Ascts

Ca pierdana.Laboratorijas testi.US., CT., MR.Tumora mareri: CEA, CA 19-9, CA 125 (izvrtjot dinamik).

TU lokalizcija.

Pankreasa galvas da: 70%Pankreasa ermea da: 20%Pankreasa astes da: 10%

Histoloija.

Metastzes.

Agrni limfatognisk un hematognisk ce (reionlie limfmezgli, aknas, peritonejs, plauas, skelet, CNS)Izplatba pieguoajs struktrs.

Komplikcijas.Ar Ca reiz notiekos pankreatts.Hiperkoagulcija trombozes, tromboflebts, embolisms.Splenomegalija pie liesas vnas obstrukcijas.Pankreasa bojjumi steatoreja, glukoses tolerances traucjumi / diabetes mellitus.Subileus / ileus.

rstana.iruriska.Staru terapija.imijterapija.vai to dada kombincija.

RADIATION TECHNIQUESSimulation and field design.

Dose prescriptions.

Treat to 45 Gy at 1.8 Gy/fx followed by conedown to 50.4 Gy. In definitive chemo-RT setting, consider boosting to 5459.4 Gy if feasible, respecting normal tissue tolerance.Multiple dose-escalation studies with hyperfractionation, brachytherapy, IORT, radiosurgery, hypofractionation, and other methods are under investigation.

Paliatva staru terapija.Paliatva staru terapija pie reionli inoperabla tumora.Paliatva staru terapija pie: spm, citiem simptomiem.Kombinta starumijterapija.

Paliatva staru terapija ar SD 20 Gy - 5 frakcijs (4 Gy frakcij) vai30 Gy - 10 frakcijs.

Dose limitations.

Doses up to 50 Gy are tolerated by small volumes of stomach and intestine. Most common late effects are mucosal ulceration and bleeding. Perforation is rare.Limit the equivalent of at least one kidney to

COMPLICATIONS.Critical normal tissues include liver, small bowel, stomach, cord, and kidney.Because the pancreas is a gland with both exocrine and endocrine secretions, both can decrease acutely or chronically following treatment. Adequate monitoring for diabetes is integral to treatment as is supplementation with pancreatic enzymes if exocrine insufficiency is suspected (pancrealipase with each meal).Acute nausea and vomiting (use antiemetics, proton pump inhibitor, or H2 blocker). Diarrhea less common. If jaundice develops during RT or following treatment, ascending cholangitis must be considered as a potential etiology.Late possible side effects include ulceration, stricture formation, obstruction, and (less commonly) perforation of GI tract. Side effects to cord, kidney, liver should not occur if normal tissue tolerances are followed.

Prognozes.

FOLLOW-UP.Laboratories, and abdominal CT every 2 months to evaluate for disease recurrence/progression.Mainly symptom-based treatment; treatment with curative intent: ultrasound examination every 3 months; relapse: primarily local or in the form of hepatic metastases

TxNxM1

The Anatomy and Clinics of Metastatic CancerBy Dr. J.M. Debois

KLUWER ACADEMIC PUBLISHERS,NEW YORK, BOSTON, DORDRECHT, LONDON, MOSCOW

I dedicate this book toDoctor James Paget (1814-1899)He was the first to observe thenon-random nature of the metastatic process.I must acknowledge:-the continuous support of my wife Kristin,-the encouragement of Prof.Marc M.Mareel, M.D.-the artistic devotion of colleague Tony Geukens, MD.-the endeavour of the Editorial Staff of Kluwer Academic Publishers

METASTASES fromCARCINOMA of the PANCREAS.

METASTASES to the PANCREAS.

Patriks Sveizijs cnoties ar vzi ir oti zaudjis svaru (8 foto).Publicts 19. aprl, 2009.Pasaules slavenajam aktierim pagjuaj gad tika konstatts vzis. Pc izieta mijas terapijas kursa aktieris sver 46 kg. Pris bildes kdu ms viu atceramies un pris bildes kds vi izskats tagad.http://das.mix.lv/articles/patriks-sveizijs-cinoties-ar-vezi-ir-loti-zaudejis-svaru-8-foto

"Patriks Sveizijs pc 20 mneu cas arslimbuodien (pirmdien) miergi aizgja no dzves, un nves brd viam ldzs bija imene," Vulfa pavstja ziu aentrai AP. Skka informcija netiek sniegta. http://www.tvnet.lv/izklaide/popkultura/42584-miris_amerikanu_kinoaktieris_patriks_sveizijs_papildinata

Savulaik Sveizijs, cieta no smaga alkoholisma, tau atkarbu prvarja. gada janvr kd intervij vi atzina, ka via slimbu, iespjams, izraisjusi ilgsto alkohola lietoana un neprtg smana.

http://izklaide.delfi.lv/archive/no-veza-miris-aktieris-patriks-sveizijs.d?id=26842369

Paldies par uzmanbu!